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Hall TAG, Cegla F, van Arkel RJ. Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants. SENSORS (BASEL, SWITZERLAND) 2024; 24:1696. [PMID: 38475232 DOI: 10.3390/s24051696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant-cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.
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Affiliation(s)
- Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Frederic Cegla
- Non-Destructive Evaluation Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
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Goossens Q, Pastrav L, Roosen J, Mulier M, Desmet W, Vander Sloten J, Denis K. Acoustic analysis to monitor implant seating and early detect fractures in cementless THA: An in vivo study. J Orthop Res 2021; 39:1164-1173. [PMID: 32844506 DOI: 10.1002/jor.24837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
The initial stability of cementless total hip arthroplasty (THA) implants is obtained by an interference fit that allows osseointegration for a long term secondary stability of the implant. Yet, finding the insertion endpoint that corresponds to an appropriate initial stability is currently often based on a number of subjective experiences of the orthopedic surgeon, which can be challenging. In order to assist the orthopedic surgeons in their pursuit to find this optimal initial stability, this study aims to determine whether the analysis of sound that results from the implant insertion hammer blows can be used to objectively monitor the insertion process of cementless THA implants. An in vivo study was conducted. The experimental results revealed vibro-acoustic behavior sensitive to implant seating, related to the low frequency content of the response spectra. This sensitive low-frequency behavior was quantified by a set of specific vibro-acoustic features and metrics that reflected the power and similarity of the low-frequency response. These features and metrics allowed monitoring the implant seating and their convergence agreed well with the endpoint of insertion as determined by the orthopedic surgeon. Intraoperative fractures caused an abrupt and opposite change of the vibro-acoustic behavior prior to the notification of the fracture by the orthopedic surgeon. The observation of such an abrupt change in the vibro-acoustic behavior can be an important early warning for loss of implant stability. The presented vibro-acoustic measurement method shows potential to serve as a decision supporting source of information as it showed to reflect the implant seating.
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Affiliation(s)
- Quentin Goossens
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Leonard Pastrav
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Jorg Roosen
- Division of Orthopedics, University Hospital Leuven, Leuven, Belgium
| | - Michiel Mulier
- Division of Orthopedics, University Hospital Leuven, Leuven, Belgium
| | - Wim Desmet
- MSD Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Kathleen Denis
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
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Hall TAG, Cegla F, van Arkel RJ. Simple Smart Implants: Simultaneous Monitoring of Loosening and Temperature in Orthopaedics With an Embedded Ultrasound Transducer. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:102-110. [PMID: 33471767 DOI: 10.1109/tbcas.2021.3052970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Implant failure can have devastating consequences on patient outcomes following joint replacement. Time to diagnosis affects subsequent treatment success, but current diagnostics do not give early warning and lack accuracy. This research proposes an embedded ultrasound system to monitor implant fixation and temperature - a potential indicator of infection. Requiring only two implanted components: a piezoelectric transducer and a coil, pulse-echo responses are elicited via a three-coil inductive link. This passive system avoids the need for batteries, energy harvesters, and microprocessors, resulting in minimal changes to existing implant architecture. Proof-of-concept was demonstrated in vitro for a titanium plate cemented into synthetic bone, using a small embedded coil with 10 mm diameter. Gross loosening - simulated by completely debonding the implant-cement interface - was detectable with 95% confidence at up to 12 mm implantation depth. Temperature was calibrated with root mean square error of 0.19°C at 5 mm, with measurements accurate to ±1°C with 95% confidence up to 6 mm implantation depth. These data demonstrate that with only a transducer and coil implanted, it is possible to measure fixation and temperature simultaneously. This simple smart implant approach minimises the need to modify well-established implant designs, and hence could enable mass-market adoption.
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Yousefsani SA, Dejnabadi H, Guyen O, Aminian K. A Vibrational Technique for In Vitro Intraoperative Prosthesis Fixation Monitoring. IEEE Trans Biomed Eng 2020; 67:2953-2964. [PMID: 32091985 DOI: 10.1109/tbme.2020.2974380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this paper, a new vibrational modal analysis technique was developed for intraoperative cementless prosthesis fixation evaluation upon hammering. METHODS An artificial bone (Sawbones)-prosthesis system was excited by sweeping of a sine signal over a wide frequency range. The exponential sine sweep technique was implemented to the response signal in order to determine the linear impulse response. Recursive Fourier transform enhancement (RFTE) technique was applied to the linear impulse response signal in order to enhance the frequency spectrum with sharp and distinguishable peak values indicating distinct high natural frequencies of the system (ranging from 15 kHz to 90 kHz). The experiment was repeated with 5 Sawbones-prosthesis samples. Upon successive hammering during the prosthesis insertion, variation of each natural frequency was traced. RESULTS Compared to classical Fast Fourier Transform, RFTE provided a better tracing and enhancement of frequency components during insertion. Three different types of frequency evolving trends (monotonically increasing, insensitive, and plateau-like) were observed for all samples, as confirmed by a new finite element simulation of the prosthesis dynamic insertion. Two main mechanical phenomena (i.e., geometrical compaction and compressive stress) were shown to govern these trends in opposite ways. Follow-up of the plateau-like trend upon hammering showed that the frequency shift is a good indicator of fixation. CONCLUSION Alongside the individual follow-up of frequency shifts, combinatorial frequency analysis provides new objective information on the mechanical stability of Sawbone-prosthesis fixation. SIGNIFICANCE The proposed vibrational technique based on RTFE can provide the surgeon with a new assistive diagnostic technique during the surgery by indicating when the bone-prosthesis fixation is acceptable, and beyond of which further hammering should be done cautiously to avoid bone fracture.
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Ghadami F, Saber-Samandari S, Rouhi G, Amani Hamedani M, Dehghan MM, Farzad Mohajeri S, Mashhadi-Abbas F, Gholami H. The effects of bone implants' coating mechanical properties on osseointegration: In vivo, in vitro, and histological investigations. J Biomed Mater Res A 2019; 106:2679-2691. [PMID: 29901269 DOI: 10.1002/jbm.a.36465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 12/26/2022]
Abstract
The main goal of this work was to investigate the effects of implants coatings' mechanical properties and morphology on the osseointegration. In order to produce different mechanical properties of coatings, two thermal spray techniques, high velocity oxy-fuel (HVOF) and air plasma spray (APS) were employed. Titanium pins were coated and implanted into the distal femurs and proximal tibias of fifteen New Zealand white rabbits, equally distributed in three study groups, and a total of 20 pins implanted in each group. Eight weeks after insertion, the rabbits were euthanized and the femur samples were taken out for biomechanical tests and tibia samples for histological evaluations of osseointegration. Scanning electron microscopy results showed enhanced density and a better morphology of HVOF coatings, compared to APS samples, and X-ray diffraction characterized an enhanced crystallinity of HVOF coatings. Nanoindentation tests revealed greater hardness and elastic modulus of HVOF coatings, whereas greater tensile residual stress and more pronounced creep was observed for APS coatings. Neither in biomechanical tests, nor in the histological analyses, a significant difference was observed between HVOF and APS coated samples (p > 0.05, and p > 0.05, respectively). The lack of significant difference between the HVOF and APS coated implants' osseointegration rejected our hypothesis to have a more enhanced osseointegration due to a better morphology, as well as stronger mechanical properties of HA coatings. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2679-2691, 2018.
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Affiliation(s)
- Farhad Ghadami
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | | | - Gholamreza Rouhi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | | | - Mohammad Mehdi Dehghan
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Saeed Farzad Mohajeri
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Fatemeh Mashhadi-Abbas
- Department of Oral and Maxillofacial Pathology, Dental School, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hossein Gholami
- Department of Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Non-radiative healing assessment techniques for fractured long bones and osseointegrated implant. Biomed Eng Lett 2019; 10:63-81. [PMID: 32175130 DOI: 10.1007/s13534-019-00120-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/04/2019] [Accepted: 07/12/2019] [Indexed: 01/08/2023] Open
Abstract
The paper provides an overview of the fracture healing process of long bones, a review of work that proposed appropriate physical parameters for the assessment of healing and highlights some recent work that reported on the development of non-radiative technique for healing assessment. An overview of the development and monitoring of osseointegration for trans-femoral osseointegrated implant is also presented. The state of healing of a fractured long bone and the stability of osseointegrated implants can be seen as engineering structural components where the mechanical properties are restored to facilitate their desired function. To this end, this paper describes non-radiative techniques that are useful for healing assessment and the stability assessment of osseointegrated implants. The achievement of non-radiative quantitative assessment methodologies to determine the state of healing of fractured long bones and to assess the stability of osseointegrated implant will shorten the patient's rehabilitation time, allowing earlier mobility and return to normal activities. Recent work on the development of assessment techniques supported by the Office of Naval Research as part of the Monitoring of Osseointegrated Implant Prosthesis program is highlighted.
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Immobilization of Denosumab on Titanium Affects Osteoclastogenesis of Human Peripheral Blood Monocytes. Int J Mol Sci 2019; 20:ijms20051002. [PMID: 30813507 PMCID: PMC6429431 DOI: 10.3390/ijms20051002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 01/03/2023] Open
Abstract
Immobilization of proteins has been examined to improve implant surfaces. In this study, titanium surfaces were modified with nanofunctionalized denosumab (cDMAB), a human monoclonal anti-RANKL IgG. Noncoding DNA oligonucleotides (ODN) served as linker molecules between titanium and DMAB. Binding and release experiments demonstrated a high binding capacity of cDMAB and continuous release. Human peripheral mononuclear blood cells (PBMCs) were cultured in the presence of RANKL/MCSF for 28 days and differentiated into osteoclasts. Adding soluble DMAB to the medium inhibited osteoclast differentiation. On nanofunctionalized titanium specimens, the osteoclast-specific TRAP5b protein was monitored and showed a significantly decreased amount on cDMAB-titanium in PBMCs + RANKL/MCSF. PBMCs on cDMAB-titanium also changed SEM cell morphology. In conclusion, the results indicate that cDMAB reduces osteoclast formation and has the potential to reduce osteoclastogenesis on titanium surfaces.
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Torrão JND, Dos Santos MPS, Ferreira JAF. Instrumented knee joint implants: innovations and promising concepts. Expert Rev Med Devices 2015. [PMID: 26202322 DOI: 10.1586/17434440.2015.1068114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article focuses on in vivo implementations of instrumented knee implants and recent prototypes with highly innovative potential. An in-depth analysis of the evolution of these systems was conducted, including three architectures developed by two research teams for in vivo operation that were implanted in 13 patients. The specifications of their various subsystems: sensor/transducers, power management, communication and processing/control units are presented, and their features are compared. These systems were designed to measure biomechanical quantities to further assist in rehabilitation and physical therapy, to access proper implant placement and joint function and to help predicting aseptic loosening. Five prototype systems that aim to improve their operation, as well as include new abilities, are also featured. They include technology to assist proper ligament tensioning and ensure self-powering. One can conclude that the concept of instrumented active knee implant seems the most promising trend for improving the outcomes of knee replacements.
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Affiliation(s)
- João N D Torrão
- a 1 Department of Mechanical Engineering, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Soares dos Santos MP, Ferreira JAF, Ramos A, Simões JAO, Morais R, Silva NM, Santos PM, Reis MC, Oliveira T. Instrumented hip joint replacements, femoral replacements and femoral fracture stabilizers. Expert Rev Med Devices 2014; 11:617-35. [PMID: 25234709 DOI: 10.1586/17434440.2014.946695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This paper reviews instrumented hip joint replacements, instrumented femoral replacements and instrumented femoral fracture stabilizers. Examination of the evolution of such implants was carried out, including the detailed analysis of 16 architectures, designed by 8 research teams and implanted in 32 patients. Their power supply, measurement, communication, processing and actuation systems were reviewed, as were the tests carried out to evaluate their performance and safety. These instrumented implants were only designed to measure biomechanical and thermodynamic quantities in vivo, in order to use such data to conduct research projects and optimize rehabilitation processes. The most promising trend is to minimize aseptic loosening and/or infection following hip or femoral replacements or femoral stabilization procedures by using therapeutic actuators inside instrumented implants to apply controlled stimuli in the bone-implant interface.
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Affiliation(s)
- Marco P Soares dos Santos
- Biomechanics Research Group, Centre for Mechanical Technology and Automation, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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